1. Statistics on teenage sexual activity, including having unprotected intercourse, demonstrate that
a. Both the abortion rate and the birth rate among adolescents are continuing to increase.
b. By age 18 to 19, the majority of adolescents have had sexual experience.
c. Teenage pregnancy in the United States was at its highest in decade between 2000 and 2010.
d. Teenage pregnancy in the United States is lower than that in at least four other industrialized nations.
ANS: B
Although there is evidence that teenagers are delaying the start of sexual activity, by age 18 or 19 the majority of both genders have had sexual experience.

DIF: Cognitive Level: Knowledge REF: p. 604

2. An adolescent is faced with a choice of engaging in sexual activity. Which of the following is the most important factor in this decision?
a. Parents beliefs and values
b. Peer pressure and the need to belong to a group of peers
c. Educational programs presented in the school
d. Religious beliefs
ANS: B
Research suggests that the main factors leading to sexual activity among teenagers are peer pressure, an adolescents need to belong to a group of peers, and the sexual content of media messages.

DIF: Cognitive Level: Application REF: p. 604

3. One of the ways adolescents are effectively avoiding sexual intercourse is by
a. Avoiding situations in which temptation and opportunity may be available.
b. Continuing to believe in a strong moral code that forbids sexual intercourse.
c. Engaging in oral sex instead.
d. Taking a pledge to remain a virgin until marriage.
ANS: C
The practice of oral sex is now as common as intercourse. About 25% of all teenagers use oral sex as a substitute for intercourse. Research suggests that teenagers do not consider oral sex to be a sexual activity.

DIF: Cognitive Level: Knowledge REF: p. 604

4. An adolescent living in the United States has chosen not to use contraception. Which of the following is the most likely reason for this decision?
a. The adolescent does not know how to use or obtain birth control.
b. The adolescent feels the need to belong to a group of peers, and those peers have suggested not using contraception.
c. The adolescent fears that condom use will interfere with the sensations enjoyed during intercourse.
d. The adolescent prefers to have sex on a spontaneous couldnt help myself basis.
ANS: A
Although there is little difference in sexual experience or age at initial sexual intercourse among teenagers in the industrialized countries, there are differences in contraceptive behaviors. Teenagers in the United States are less likely to know contraceptive methods, to know how to obtain contraceptives, or to use contraceptives. Peer pressure and the need for belonging to a peer group do influence the choice to engage in sexual activity, but the major problem related to lack of contraceptive use in the United States is the lack of education.

DIF: Cognitive Level: Application REF: p. 604

5. On the federal level, American policy on adolescent sexuality is
a. Ambivalent about sex education, with restricted access to contraception.
b. Focused on abstinence-only programs with or without parental approval.
c. Restricted to federal funding for clinics for financially disadvantaged adolescents.
d. Supportive of comprehensive sex education, including contraceptive services.
ANS: A
The United States is ambivalent about sex education; abstinence is strongly encouraged, and several federal efforts have been made to restrict access to reproductive services. Parental permission requirements are one example of such restrictions.

DIF: Cognitive Level: Knowledge REF: pp. 604-606

6. Which of the following statements regarding adolescent male and female motivation for sexual intercourse is accurate?
a. Female adolescents desire intimacy, whereas male adolescents enjoy the physical pleasure and social status.
b. Female adolescents love the acceptance and attention, whereas male adolescents enjoy the control and power.
c. Female adolescents want to be like everyone else, whereas male adolescents consider sex a game.
d. Female adolescents try to keep male adolescents interested in them, whereas male adolescents want to report a conquest.
ANS: A
The motives for intercourse are different by gender: For teenage girls, intimacy is the most important reason, whereas teenage boys list physical pleasure and social status as more important.

DIF: Cognitive Level: Comprehension REF: pp. 604-606

7. Which of the following is probably most influential in delaying when an adolescent begins engaging in sexual intercourse?
a. Academic motivation and orientation toward the future
b. Availability and cost of contraceptives
c. Gender and socioeconomic status
d. Racial/ethnic group
ANS: A
Students who are academically motivated, are progressing well in school, are future oriented, and have established goals generally delay sexual activity. Parental expectations also influence teenagers of both genders to postpone sexual activity.

DIF: Cognitive Level: Comprehension REF: p. 606

8. Which of the following aggregates is most likely to delay sexual activity?
a. Teenagers from single-parent homes
b. Teenagers who are doing well in school and planning to attend college
c. Teenagers who are or have been sexually abused
d. Teenagers who engage in smoking, drinking, and using drugs
ANS: B
Studies reveal that students who are academically motivated and progressing well in school generally delay sexual activity. Adolescents from single-parent families with fewer support sources and adolescents who engage in risky behaviors have sex earlier than do teenagers from families in which both parents are present and teenagers who do not engage in smoking, drinking, or drug use.

DIF: Cognitive Level: Application REF: pp. 606-607

9. Research findings have suggested that adolescents who engage in sexual activity at earlier ages may also be at risk for
a. Alcoholism and heavy drug use.
b. Depression and suicide.
c. Ridicule and harassment by peers who are not sexually active.
d. Unemployment and financial hardships.
ANS: B
Sexually active teenagers are three times more likely to feel depressed and are at greater risk for suicide than are teenagers who are not sexually active.

DIF: Cognitive Level: Knowledge REF: pp. 606-607

10. Which of the following concerning sexually transmitted diseases (STDs) in the United States is true?
a. Infected men are usually aware that they have an STD.
b. Of the 10 most prevalent infectious diseases, 5 are STDs.
c. Most STD infections are spread by direct contact.
d. More men than women are infected with STDs.
ANS: B
Of the 10 most prevalent infectious diseases, 5 are STDs: Chlamydia infection, gonorrhea, acquired immune deficiency syndrome (AIDS), syphilis, and hepatitis B. Men are usually asymptomatic and do not generally seek reproductive health care services, and their infections are more likely to go undetected. Infections can be spread multiple ways, such as through direct contact. The rates of chlamydia and gonorrhea are higher among women than among men.

DIF: Cognitive Level: Comprehension REF: p. 607

11. In comparisons of costs and outcomes of health care among countries, what is true about the United States outcomes in relation to adolescent pregnancies?
a. The rate of adolescent pregnancies is lower in the United States than in most other industrialized nations.
b. The rate of adolescent pregnancies is about the same in the United States as in other industrialized nations.
c. The rate of adolescent pregnancies is higher in the United States than in most other industrialized nations.
d. The rate of adolescent pregnancies is lower in the United States than in most other industrialized nations but is rising rapidly.
ANS: C
The rate of adolescent pregnancies in the United States is one of the highest pregnancy rates among industrialized nations.

DIF: Cognitive Level: Comprehension REF: p. 607

12. What trends have occurred in the teenage pregnancy rate in the United States?
a. It remained consistent from 2004 to 2009.
b. It has continued to rise.
c. It has been fluctuating rather wildly.
d. It has remained high, but rates are decreasing.
ANS: D
Preliminary data through 2009 indicate a sharp decline in teenage pregnancy rates and a moderate decline in birth and abortion rates among adolescents.

DIF: Cognitive Level: Knowledge REF: p. 608

13. An 18-year-old adolescent learns that she is pregnant. She knows her choices are abortion, adoption, or keeping her newborn. Statistically, she is more likely to
a. Abort the products of conception.
b. Keep her newborn.
c. Marry the father and make a mutual decision.
d. Put her infant up for adoption.
ANS: B
Today, most pregnant teenagers decide to keep their babies. Approximately 66% choose childbirth, and 25% choose abortion. Most unwed mothers keep their infants. Few teenagers opt for marriage if they become pregnant.

DIF: Cognitive Level: Application REF: p. 608

14. In relation to ethnic groups, which of the following statements concerning teenage pregnancies is true?
a. African American teenagers have the highest number of pregnancies and births.
b. Asian or Pacific Islander teenagers have the highest number of pregnancies and births.
c. White teenagers have the highest number of pregnancies and births.
d. Hispanic teenagers have the highest number of pregnancies and births.
ANS: C
The majority of teenage pregnancies are among white adolescents. However, African Americans are at greater risk for adolescent pregnancy. Hispanic and black teenagers have a higher proportional rate of adolescent pregnancy, but because they are fewer in number, the largest number of teenage births is to white mothers.

DIF: Cognitive Level: Comprehension REF: p. 609

15. Which of the following statements about the United States outcomes in relation to abortion is true?
a. The abortion rate is lower in the United States than in other industrialized nations.
b. The abortion rate is about the same in the United States as in other industrialized nations.
c. The abortion rate is higher in the United States than in other industrialized nations.
d. The abortion rate is higher among white teenagers in the United States than among white teenagers from other industrialized nations.
ANS: C
Although abortion is common in all five industrialized nations, the rate is highest in the United States.

DIF: Cognitive Level: Comprehension REF: p. 609

16. Which of the following is a reason why teenage pregnancy is viewed as a community problem?
a. Teenage pregnancy is inconsistent with community values and norms.
b. Pregnant teenagers are poor role models for younger children.
c. The community pays financially for the consequences of teenage pregnancy.
d. There are cultural and social sanctions against adolescent sexuality.
ANS: C
Public funds (ultimately all taxpayers) pay for much of the care and consequences associated with teenage pregnancies, including the cost of treating sexually transmitted diseases (STDs), prenatal care, and support costs such as Temporary Assistance to Needy Families (TANF), Women, Infants, and Children (WIC), and Medicaid.

DIF: Cognitive Level: Comprehension REF: p. 611

17. A young teenager has recently had a baby. Which of the following is most probable for this infant?
a. Increased attention
b. Increased risk of health problems
c. Increased incidence of high birth weights
d. Increased success in school
ANS: B
Teenage motherhood is a risk factor for the infant. Stillbirths are twice as common among infants born to teenage mothers as among infants born to mothers in their twenties, and the mortality rate is higher. Babies born to very young mothers are at greater risk for health problems and hospitalization than are babies born to older mothers.

DIF: Cognitive Level: Application REF: p. 612

18. A teenager has just learned she is pregnant. Which of the following is the most expected response by the family?
a. The family will draw closer together as they confront this new family crisis.
b. The family will likely distance themselves from their daughter.
c. The family will be excited to play with the new baby.
d. The family will have unexpected economic and emotional pressure.
ANS: D
The family now has added economic and emotional pressure, which is often a burden with which the family is not equipped to deal. Grandparents may become the infants primary caregivers, and siblings and other family members become resentful of the added burden.

DIF: Cognitive Level: Application REF: pp. 612-613

19. With regard to the ages of the fathers, the majority of the fathers involved in teenage pregnancies are
a. About the same age as the teenage mother.
b. Several years older than the teenage mother.
c. Undetermined; studies have not yet determined this information.
d. Younger than the teenage mother.
ANS: B
One third of men aged 25 to 29 years have female partners that are either 3 to 6 years younger or 7 or more years younger. One study of California teenage mothers revealed that the fathers of their babies were an average of 3 years older than the mothers. Boys aged 19 and younger rarely father a child; they are not responsible for most pregnancies among adolescent girls.

DIF: Cognitive Level: Knowledge REF: p. 614

20. A pregnant teenager tells the community/public health nurse that the babys father is very involved in her pregnancy, but she wonders if this will continue in the future. Which of the following best describes the most likely involvement by teenage fathers?
a. Fathers are involved through delivery, but then the relationship dissipates.
b. Fathers are not involved with the mother once the pregnancy is known.
c. Fathers contribute financially to the childs upbringing as much as they are able.
d. Fathers remain involved with the mother and her infant for several years.
ANS: A
Studies have demonstrated that the babys father is generally available to the pregnant teenager before delivery, but their relationship weakens over time. Most such fathers are still involved at delivery. By the time the child is 5 years old, only a handful of these fathers have regular contact with the mother or child.

DIF: Cognitive Level: Application REF: pp. 614-615

21. The young woman was requesting prenatal services, although she admitted that her family did not know about her pregnancy. Under what condition could she receive services without her parents consent?
a. She and her 17-year-old boyfriend have been living in their own apartment for 6 months.
b. She has worked part-time for years while attending high school.
c. She is employed as an aide in a legal office on Saturdays and might sue the health care agency if she does not receive the care she is requesting.
d. She is living with her grandmother, not her parents.
ANS: A
States define emancipated adolescents as those who are married, those who are members of the armed forces, and those who are living apart from their parents. Living independently is often accepted as demonstrating that the adolescent is emancipated and can make her own medical decisions.

DIF: Cognitive Level: Application REF: p. 615

22. A 15-year-old mother was living with her parents, who supported her and her newborn child. She held the baby while the first series of immunizations was given to the infant. However, when it was time for her own tetanus shot booster, there was a problem. What might have been the problem?
a. Although she can consent to her newborns care, she needs parental consent for her own.
b. The young mother could not have an immunization while breast-feeding a baby.
c. The young mother should not have an immunization until she has had her postpartum checkup.
d. The period after childbirth is an inappropriate time for a new mother to receive an immunization.
ANS: A
As the mother, she can give consent for care to be given to her newborn; as a minor, however, she needed parental consent for her own care.

DIF: Cognitive Level: Application REF: p. 615

23. Which of the following programs demonstrates the use of primary prevention?
a. Intense human immunodeficiency virus (HIV) prevention education program with distribution of free condoms
b. Group meetings and counseling of new mothers to help with family coping
c. Peer counselors visiting pregnant teenagers and offering suggestions
d. Volunteers educating the families of pregnant teenagers to ensure early prenatal care
ANS: A
Only the HIV prevention education program represents primary prevention. All the other options represent secondary or tertiary intervention. Distribution of free condoms would also eliminate the barrier of being unable to afford contraceptives.

DIF: Cognitive Level: Application REF: p. 615

24. Which of the following is true with regard to federally funded abstinence-only programs?
a. They persuade young persons to postpone sexual activity.
b. They help young persons avoid pregnancy and transmission of sexually transmitted diseases (STDs).
c. They are ineffective in reducing sexual activity, STDs, and pregnancies.
d. They reinforce the reasons to avoid sexual activity until after marriage.
ANS: C
There is little evidence that abstinence-only programs are successful in curtailing sexual activity until marriage or in reducing STDs or pregnancy among adolescents. Research showed no difference in outcomes related to sexual activity and unprotected sex between teenagers who attended such a program and those who did not.

DIF: Cognitive Level: Comprehension REF: p. 615

25. A nurse encourages a pregnant teenager to attend a prenatal clinic. This an important nursing intervention because pregnant teenagers are more likely to
a. Need adoption counseling.
b. Have poor nutrition and lifestyle habits.
c. Ignore their pregnancy.
d. Have gestational diabetes.
ANS: B
The problems of teenage pregnancy not only are caused by age but also result from lower socioeconomic status, poor prenatal care, inadequate nutrition, and unhealthy lifestyle practices.

DIF: Cognitive Level: Application REF: p. 616

26. A community/public health nurse is completing a home visit with a new teenage mother and her infant. Which of the following observations should the nurse make?
a. Evidence of adequate maternal and infant bonding
b. Evidence that the grandmother is taking over care of the infant
c. Evidence that the mother has applied for assistance programs
d. Evidence of adequate involvement by the father
ANS: A
The nurse should, in addition to the usual newborn assessment, look for signs of adequate maternal and infant bonding and evidence of attachment. Infants of young unwed mothers are at high risk for child abuse and neglect. It is important that the mother receive support from other people, but it is not appropriate for the grandmother to take over care, nor does the father need to be involved if other supports are in place. Also, it is not always necessary for the mother to apply for assistance programs.

DIF: Cognitive Level: Application REF: p. 616

27. When making a home visit to a new teenage mother and her infant, the community/public health nurse watched the new mother change her babys wet diaper and then carefully wrap a long length of cloth around the babys abdomen covering the umbilical cord stump. What should the nurse do about the mothers behavior?
a. Ignore this cultural tradition if the baby is not harmed.
b. Recognize that this is evidence that the grandmother is taking over care.
c. Inform the mother that the use of such a cloth serves no purpose and should be stopped.
d. Investigate the purpose of this cloth.
ANS: A
Cultures vary in child care custom and practices. There is no reason to discourage or eliminate a tradition if it does no harm. The use of cultural traditions does not mean that the grandmother is taking over care.

DIF: Cognitive Level: Application REF: p. 616

28. After the stress of having a child at such an early age, being in (or needing to be in) school, and having difficulties with employment, most young mothers
a. Are careful to use birth control to avoid further pregnancies.
b. Are so angry at men that they do not engage in sexual relationships.
c. Become pregnant again while still a teenager.
d. Postpone further childbearing until they are through school and have a good job.
ANS: C
Statistics show that teenagers who are parents are at significant risk for having another child while they are still teenagers.

DIF: Cognitive Level: Comprehension REF: p. 617

29. A community/public health nurse implemented a home visiting program with a teenage mother and child from the prenatal period through the childs second birthday. Which of the following long-term effects would be most likely?
a. The program assisted this child in becoming a well-adjusted young adult.
b. The cost of this program was too high for it to be continued for other children.
c. The program was too short to have any lasting effects that could be measured.
d. The support from a nurse was insufficient to create long-term improvements.
ANS: A
The Nurse Home Visiting Program provided care from the prenatal period through the infants second birthday; however, the results appeared to continue long term (Olds et al., 1999). The women who participated in this program deferred subsequent pregnancies and improved their workforce participation. Their children had fewer arrests and convictions, smoked and drank less, and had fewer sexual partners than did their peers.

DIF: Cognitive Level: Application REF: p. 618

MULTIPLE RESPONSE

1. Healthy People 2020 objectives include which of the following? (Select all that apply.)
a. Distribution of free condoms in public high schools
b. Assisting adolescents in learning gender anatomy, physiology, and functioning
c. Delaying the age at first intercourse
d. Establishing sex/family education in all public schools
e. Increasing the use of protective measures during sexual activities
f. Reducing the number of adolescents engaging in sexual activity
ANS: C, E, F
The identified priorities associated with teenage sexual activity in Healthy People 2020 are increasing the age at first intercourse, reducing the number of adolescents engaging in sexual activity, and increasing the number of adolescents who use protective measures when engaging in sexual activity.

DIF: Cognitive Level: Knowledge REF: p. 618

2. A teenager has recently discovered that she is pregnant. Which of the following consequences is she likely to experience? (Select all that apply.)
a. Admiration, but also jealousy, among friends who do not have an infant
b. Greater risk of poverty for her and her infant
c. Increased risk of lower education and fewer employment choices
d. Loss of friends and peers who get tired of baby-sitting
e. Marriage to a man whom she does not love
f. Upset family dynamics as the infants grandparents assist with child care
ANS: B, C, F
Among the consequences of pregnancy among adolescents are increased risk of medical complications and poorer outcomes for the mother. Education may be jeopardized, which endangers future employment expectations and hence results in a greater risk for poverty with all its negative outcomes.

DIF: Cognitive Level: Application REF: p. 620

3. What documented consequences are seen among infants of adolescent mothers? (Select all that apply.)
a. Having to accept charity and gifts from other family members
b. Higher incidence of child abuse and neglect
c. Increased risk of lower education and hence fewer employment choices
d. Lower probability of a successful marriage in adulthood
e. Mortality rate two to four times higher than that among other infants and twice the risk of stillbirths
f. Risk of infant daughter also becoming an unwed teenage mom at an early age
ANS: B, C, E, F
Stillbirths are twice as common among the infants of teenagers, and the mortality rate is two to four times higher during the first year of life for infants born to adolescents. Also, babies born to young mothers are at increased risk for child abuse and neglect, for poorer cognitive development, and for poorer educational achievement.

DIF: Cognitive Level: Comprehension REF: p. 621

4. Which of the following statements reflect the effect that teenage pregnancy has on the family? (Select all that apply.)
a. When the teenager attends school, her parents must become the primary caregivers.
b. The infants grandparents may have to become infant caregivers again.
c. Older siblings may fight for the chance to be the infants baby-sitter during evenings.
d. The teenage mothers siblings get to enjoy playing with the infant.
e. The teenage mother requires more of her parents financial resources to manage.
f. The family may not be equipped to deal with the economic and emotional pressures.
ANS: B, E, F
The newborn infant affects members of the family with changes in family pattern and routine. The teenage mothers siblings can become resentful because they may have to compete for attention. Family members may have less privacy and may have to share resources. The grandparents may have to assume economic costs, as well as infant care responsibilities. The family may not be equipped to deal with the economic and emotional pressure, and such pressure is often a burden.

DIF: Cognitive Level: Comprehension REF: p. 623

5. A 15-year-old girl came to the free clinic for care as she had become sexually active some time ago and decided she needed to obtain appropriate health care. What care can the clinic probably give to her without involving her parents? (Select all that apply.)
a. An abortion if that is her decision
b. Antibiotics for a skin infection from scratching her acne
c. Birth control pills or Depo-Provera
d. Pap smear and routine gynecologic care
e. Pregnancy tests and prenatal care if she is pregnant
f. Diagnosis of and treatment for any sexually transmitted disease (STD)
ANS: D, E, F
In any state, the conservative answers would be pregnancy tests, prenatal care, and care for any STD. All 50 states allow treatment for care of STDs, although two states (Texas and Utah) do not allow use of state funds for that purpose. Contraception availability depends on the state. Abortions are severely restricted.

DIF: Cognitive Level: Application REF: p. 624

6. A community/public health nurse is developing programming for the community to reduce adolescent sexual activity and teenage pregnancy. Which of the following options would be the most appropriate? (Select all that apply.)
a. A signed commitment to delay sexual intercourse until marriage (virgin pledges)
b. Off-site abstinence program
c. On-site (at the school) abstinence program
d. The Care for Your Egg family-life program
e. School-based clinics with comprehensive services
f. Teenage mothersgrandmothers program
ANS: D, E
School-based clinics have successfully reduced the rates of sexual intercourse and pregnancy among teenagers in a growing number of communities. Comprehensive family life programs have also been shown to be successful. A teenage mothersgrandmothers program would undoubtedly be helpful after delivery but not in preventing such pregnancies.

DIF: Cognitive Level: Application REF: p. 625

7. A pregnant teenage girl is considering abortion. Which of the following are reasons why she may choose abortion? (Select all that apply.)
a. She believes that being pregnant will ruin her figure and no one will want to date her.
b. She cannot afford a child now.
c. She cannot trust the father to support her and the baby.
d. She does not want anyone to know that she is pregnant.
e. She believes that she is too young to be a mother.
f. She believes that her parents will not support her if they find out that she is pregnant.
ANS: B, C, E
The most common reasons teenagers give for choosing abortion are as follows: being too young to be a mother, being unable to afford a child now, believing that a baby would change her life, believing that parents would want her to have an abortion, and unreliability of the partner.